1. Pediatric HIV/AIDS Nikki Dieker

2. AIDS Statistics Today 40 million people are estimated to be living with HIV/AIDS including 3 million children Today 40 million people are estimated to be living with HIV/AIDS including 3 million children During 2001, AIDS caused the deaths of roughly 3 million people including 580,000 children During 2001, AIDS caused the deaths of roughly 3 million people including 580,000 children 95% of the people that have HIV live in the developing world 95% of the people that have HIV live in the developing world CDC Division of HIV/AIDS Prevention

3. HIV/AIDS Statistics Cont Half of the 5 million new infections in the past year occurred among individuals between 15 and 24 years of age Half of the 5 million new infections in the past year occurred among individuals between 15 and 24 years of age In the United States one quarter of new infections occur in youths age 13-21 at a rate of one new infection every hour In the United States one quarter of new infections occur in youths age 13-21 at a rate of one new infection every hour Children’s Friends for Life

4. AIDS Orphans Includes children who have lost either their father, mother, or both to AIDS Includes children who have lost either their father, mother, or both to AIDS By 2010 there will be 25 million living AIDS orphans By 2010 there will be 25 million living AIDS orphans Earlier estimates put the number at 40 million, but it does not take into account the 15 million AIDS orphans that will die in the next 8 years Earlier estimates put the number at 40 million, but it does not take into account the 15 million AIDS orphans that will die in the next 8 years UNICEF and UNAIDS

5. Mother to Infant Transmission Without interventions 35% of infants born to HIV-positive mothers will contract HIV Without interventions 35% of infants born to HIV-positive mothers will contract HIV Of these: Of these: 15-20% occur during pregnancy 15-20% occur during pregnancy 50% occur during labor and delivery 50% occur during labor and delivery 33% occur during breastfeeding 33% occur during breastfeeding

6. The Breastfeeding Dilemma Infants can contract HIV through breastfeeding Infants can contract HIV through breastfeeding In developing countries formula is often not available or extremely expensive In developing countries formula is often not available or extremely expensive If formula is available, clean water often is not If formula is available, clean water often is not

7. Diagnosis An infant less than 18 months of age is considered HIV-infected if they are seropositive, or were born to an HIV infected mother and has positive results on two separate HIV tests An infant less than 18 months of age is considered HIV-infected if they are seropositive, or were born to an HIV infected mother and has positive results on two separate HIV tests An infant can be excluded by the disappearance of anti-HIV antibody by 18 months of age (seroreversion) An infant can be excluded by the disappearance of anti-HIV antibody by 18 months of age (seroreversion)

8. Major Problems Associated with HIV/AIDS Malnutrition Malnutrition Growth failure Growth failure Developmental delays Developmental delays Micronutrient deficiencies Micronutrient deficiencies Neurological problems Neurological problems Opportunistic infections Opportunistic infections Normal childhood illnesses are potentially fatal Normal childhood illnesses are potentially fatal

9. Problems Continued If you have a child with AIDS you generally have a family with AIDS If you have a child with AIDS you generally have a family with AIDS Socioeconomic status Socioeconomic status Access to medication Access to medication

10. Malnutrition Impaired nutritional absorption Impaired nutritional absorption Increased nutritional requirements Increased nutritional requirements Reduced food intake Reduced food intake

11. Impaired Nutritional Absorption HIV-induced diarrhea HIV-induced diarrhea Dehydration Dehydration Lactose intolerance Lactose intolerance Opportunistic infections Opportunistic infections Cryptosporidioses Cryptosporidioses Tuberculosis Tuberculosis Gastric acid hypersecretion Gastric acid hypersecretion Drug interactions Drug interactions

12. Increased Nutritional Requirements Metabolic activity changes Metabolic activity changes Alterations in the function of the GI tract Alterations in the function of the GI tract Alteration in their ability to use food efficiently Alteration in their ability to use food efficiently Increased use of body fat stores Increased use of body fat stores Recurrent fevers and infections Recurrent fevers and infections Depletion of vitamin and mineral stores Depletion of vitamin and mineral stores Increased calorie needs Increased calorie needs

13. Reduced Food Intake Partially due to neurological involvement Partially due to neurological involvement Abnormal swallowing mechanisms Abnormal swallowing mechanisms Gastroesophageal reflux Gastroesophageal reflux Aspiration Aspiration Decrease in taste and appetite Decrease in taste and appetite Regression of eating skills Regression of eating skills Oral lesions and HIV-specific gingivitis and gum disease Oral lesions and HIV-specific gingivitis and gum disease Drug induced nausea, gastric irritation and drug volume and schedules Drug induced nausea, gastric irritation and drug volume and schedules Psychological problems such as depression Psychological problems such as depression

14. Neurological and Developmental Problems Impaired brain growth Impaired brain growth Progressive motor dysfunction Progressive motor dysfunction Loss or leveling out of developmental milestones Loss or leveling out of developmental milestones Seizures Seizures Strokes Strokes

15. Nutrient Deficiencies Vitamin A (18-50%) Vitamin A (18-50%) Vitamin E (27%) Vitamin E (27%) Vitamin C (7%) Vitamin C (7%) Riboflavin (26%) Riboflavin (26%) Vitamin B6 (53%) Vitamin B6 (53%) Vitamin B12 (23%) Vitamin B12 (23%) Copper (74%) Copper (74%) Zinc (50%) Zinc (50%) Selenium (10%) Selenium (10%)

16. Nutritional Assessment Detailed diet history Detailed diet history Medication history Medication history Anthropometric data Anthropometric data Evaluation of weight changes Evaluation of weight changes Laboratory data Laboratory data

17. What can be done? Early culturally acceptable dietary intervention may help avoid growth failure Early culturally acceptable dietary intervention may help avoid growth failure Small frequent feedings Small frequent feedings Nutrient supplementation Nutrient supplementation Soft-textured, moist foods, at room temperature (casseroles, eggs, pasta, and gravy on meats) Soft-textured, moist foods, at room temperature (casseroles, eggs, pasta, and gravy on meats) Fluids may be tolerated better through a straw Fluids may be tolerated better through a straw

18. What can be done? A tolerable anti-HIV regimen including a combination of three different medications, two reverse transcriptase inhibitors and a protease inhibitor can cause weight gain, improved mental functioning and a longer life A tolerable anti-HIV regimen including a combination of three different medications, two reverse transcriptase inhibitors and a protease inhibitor can cause weight gain, improved mental functioning and a longer life Aggressive treatment of opportunistic infections can prevent the deterioration of nutritional status Aggressive treatment of opportunistic infections can prevent the deterioration of nutritional status Estimate energy needs using a Metabolic Cart, RDA tables or the Bentler and Stannish formula for catchup growth Estimate energy needs using a Metabolic Cart, RDA tables or the Bentler and Stannish formula for catchup growth May be up to 200 kcal/kg and 4g protein/kg May be up to 200 kcal/kg and 4g protein/kg

19. What can be done? Evaluate feeding skills to see if tube feeding is necessary or total parenteral nutrition is necessary Evaluate feeding skills to see if tube feeding is necessary or total parenteral nutrition is necessary For diarrhea: For diarrhea: Lactaid milk and yogurt products Lactaid milk and yogurt products Soy milk Soy milk Soluble forms of fiber (oatmeal, rice, bananas, applesauce) Soluble forms of fiber (oatmeal, rice, bananas, applesauce) Replace fluid loss with electrolyte solutions such as Pedialyte Replace fluid loss with electrolyte solutions such as Pedialyte

20. Tips for Caregivers Watch for any changes in your child’s behavior Watch for any changes in your child’s behavior Talk to your doctor before you give your child any immunizations or booster shots Talk to your doctor before you give your child any immunizations or booster shots Plastic and washable toys are preferred Plastic and washable toys are preferred Food safely is vital Food safely is vital These children need a lot of love, don’t be afraid to touch them These children need a lot of love, don’t be afraid to touch them

21. Reference Eley B, Hussey G. Nutrition and human immunodeficiency virus in children. SA J Clin Nutr. 1999;89:190-195. Eley B, Hussey G. Nutrition and human immunodeficiency virus in children. SA J Clin Nutr. 1999;89:190-195.

22. Any Questions?